子宫输卵管四维超声造影疼痛副反应发生率及严重程度的临床研究

Clinical study on the incidence and severity of pain reactions in transvaginal 4-dimentional hystero-salpingo contrast sonography

目的:分析子宫输卵管四维超声造影(4D-HyCoSy)疼痛副反应发生率及严重程度,探讨其在不孕症诊断中的临床应用价值。方法:采用造影剂SonoVue对1306例女性不孕症患者行4D-HyCoSy检查,并对造影显示双侧或单侧输卵管阻塞的215例患者行腹腔镜下输卵管通液术对比研究,分析不同程度输卵管通畅度的疼痛副反应发生率及严重程度。结果:1306例患者均能顺利完成4D-HyCoSy检查,其中215例与腹腔镜输卵管通液术对比研究显示,4D-HyCoSy判断输卵管通畅/通而不畅的敏感性、特异性和准确度均高于90%,诊断输卵管阻塞的上述统计学指标均为100%。不同程度输卵管通畅度的疼痛反应发生率由高到低依次分别为:双侧输卵管阻塞>一侧阻塞对侧通而不畅>一侧阻塞对侧通畅>两侧通而不畅>一侧通畅对侧通而不畅>两侧输卵管通畅,组间差异均有统计学意义(P<0.01)。研究发现,输卵管通畅度越差,疼痛副反应的严重程度也就越高,其中双侧输卵管阻塞的病例最易发生3级疼痛反应(占该类患者疼痛的17.73%),双侧输卵管通畅的疼痛级别最低(其中0~1级疼痛的比例高达98.36%)。结论:4D-HyCoSy是一种能安全、有效的准确判断输卵管通畅度的影像检查新技术,可作为评价输卵管通畅度的首选检查方法。

Objective To analyze the incidence and severity of pain reactions in transvaginal 4-dimentional hystero-salpingo contrast sonography(4D-HyCoSy),and to investigate its clinical value for the diagnosis of infertility.Methods 1306 female infertility patients were examined by transvaginal 4D-HyCoSy with contrast agent SonoVue,and 215 patients with bilateral or unilateral fallopian tube obstruction were examined by laparoscopy.The incidence and severity of pain reactions in different patency of fallopian tube were compared.Results All 1306 patients were successfully examined by 4D-HyCoSy.The results of laparoscopy were used as diagnostic criteria.The sensitivity,specificity and accuracy of 4D-HyCoSy in diagnosis of unobstructed/partial obstruction fallopian tube were all higher than 90%.The above statistical indicators of 4D-HyCoSy in diagnosis of fallopian tube obstruction were all up to 100%.Patients with tubal obstruction were more prone to have pain than unobstruction cases,and patients with bilateral obstruction were more prone to have pain than unilateral obstruction.The worse of the tubal patency was,the higher of the severity of pain response was,of which 3 levels of pain response was the most likely to occur in cases of bilateral fallopian tube obstruction(17.73%of the pain in this type of patients).The pain level of bilateral unobstructed fallopian tubes was the lowest(0 and 1 were 98.36%).Conclusion 4D-HyCoSy is a new imaging technique which can accurately and safely judge the patency of fallopian tubes.It can be used as the preferred examination method for evaluating the patency of fallopian tubes.